Morphometric Analysis of the Infraorbital Foramen in Children and Adolescents with Unilateral Cleft Lip and Palate: A CBCT Study

TL;DR

This study uses CBCT scans to compare infraorbital foramen distances in children with unilateral cleft lip and palate, finding side-specific variations that impact nerve block placement.

Contribution

The study provides new morphometric data on infraorbital foramen asymmetry in unilateral cleft lip and palate patients using CBCT.

Findings

Distances from the infraorbital foramen to several anatomical landmarks are significantly shorter on the cleft side.

Distances to ANS and J are longer on the cleft side compared to the non-cleft side.

No significant differences were found in IOF-TM distances or soft tissue thickness between sides.

Abstract

What are the main findings?
On the cleft side (CS), the distances of IOF-IOM, IOF-SOM, IOF-S, IOF-N, IOF-LAP, and IOF-M were found to be significantly shorter than those on the non-cleft side (NCS). Conversely, the distances of IOF-ANS and IOF-J were significantly longer on the CS than on the NCS.No significant differences were observed between the CS and NCS regarding the IOF-TM and IOF-STT distances.

On the cleft side (CS), the distances of IOF-IOM, IOF-SOM, IOF-S, IOF-N, IOF-LAP, and IOF-M were found to be significantly shorter than those on the non-cleft side (NCS). Conversely, the distances of IOF-ANS and IOF-J were significantly longer on the CS than on the NCS.

No significant differences were observed between the CS and NCS regarding the IOF-TM and IOF-STT distances.

What is the implication of the main finding?
On the CS, compared to the NCS, the injection site for inferior nerve block (INB) should be planned slightly more superior and medial.In INB applications, it has been clearly demonstrated that the standard needle depth can be used safely on both sides.

On the CS, compared to the NCS, the injection site for inferior nerve block (INB) should be planned slightly more superior and medial.

In INB applications, it has been clearly demonstrated that the standard needle depth can be used safely on both sides.

Aim: A precise understanding of the morphometric characteristics of the infraorbital foramen (IOF) is essential for ensuring safe and effective surgical interventions and regional anesthesia in children and adolescents with cleft lip and palate (CLP). This study aimed to investigate the morphometric characteristics of the IOF using CBCT in children and adolescents with unilateral cleft lip and palate (UCLP) and to compare the cleft side (CS) with the non-cleft side (NCS). Materials and Method: CBCT scans of 48 individuals with UCLP were analyzed, evaluating a total of 96 IOFs. Reference anatomical landmarks included the supraorbital margin (SOM), infraorbital margin (IOM), nasion (N), anterior nasal spine (ANS), tuber maxilla (TM), sella (S), lateral margin of the apertura piriform (LAP), jugale (J), and midline (M). Distances from the IOF to these landmarks were measured and compared between the CS and NCS. Soft tissue thickness over the IOF was also assessed, and the IOF shape was evaluated separately for each side. Results: The V-oval form was the most common IOF shape on both sides. No significant differences were found in vertical or horizontal diameters between the CS and NCS (p > 0.05). Distances from the IOF to IOM, SOM, S, N, LAP, and midline were significantly shorter on the CS (p < 0.05), whereas distances to ANS and J were significantly longer on the CS (p < 0.05). No significant differences were observed in IOF-TM distances or soft tissue thickness (p > 0.05). Conclusions: In individuals with UCLP, the IOF exhibits significant side-specific variations relative to key anatomical landmarks. These differences should be considered in infraorbital nerve block administration and surgical planning to improve accuracy and safety.

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